Stability of Bio-Intact (1–84) Parathyroid Hormone ex Vivo in Serum and EDTA Plasma from Hemodialysis Patients

Teal, T.K.; Wood, Joanna L.; Stevens, Paul E.; Lamb, Edmund J.

doi:10.1373/clinchem.2004.037994

Cited by 14 publications

(9 citation statements)

References 7 publications

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“…It is also broadly in accord with advice provided in manufacturers' kit inserts, most of which suggest measurement of PTH in either EDTA plasma or serum, but confirm that PTH is more stable in EDTA plasma than serum (Table 4, [35,37,47]). We accept that PTH is commonly measured in conjunction with calcium, and sometimes vitamin D, to permit interpretation and that this recommendation will necessitate an additional sample being taken since calcium cannot be measured in EDTA plasma.…”

Section: We Recommend Blood Samples For Pth Measurement Should Be Taksupporting

confidence: 71%

“…We found no direct published comparisons of observed analyte stability with second versus third generation PTH assays but there were some data to suggest that PTH may be more stable when measured by third rather than second generation assays [37]. This could be explained on the basis that the peptide fragments detected by the second generation assays may be less stable than the intact molecule detected by third generation assays.…”

Section: Limitationsmentioning

confidence: 85%

“…Eighteen papers studying PTH stability in separated serum and plasma using second generation (Supplemental Data Table 4) [19, 20, 22-25, 27, 29, 31-35, 38-42] and four using third generation (Supplemental Data Table 5) [30,36,37,43] assays were identified. PTH stability in EDTA plasma and serum was directly compared in seven studies using second generation assays [25,29,[31][32][33][34][35].…”

Section: Stability In Separated Serum and Plasma At Room Temperaturementioning

confidence: 99%

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Sampling and storage conditions influencing the measurement of parathyroid hormone in blood samples: a systematic review

Hanon

Sturgeon

Lamb

2013

Clinical Chemistry and Laboratory Medicine (CCLM)

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Parathyroid hormone (PTH) is relatively unstable: optimisation of pre-analytical conditions, including specimen type, sampling time and storage conditions, is essential. We have undertaken a systematic review of these pre-analytical conditions. An electronic search of the PubMed, Embase, Cochrane, Centre for Research and Dissemination and Bandolier databases was undertaken. Of 5511 papers identified, 96 underwent full text review, of which 83 were finally included. At room temperature PTH was stable in ethylenediaminetetraacetic acid (EDTA) preserved whole blood for at least 24 h and in EDTA plasma for at least 48 h after venepuncture. Losses were observed in clotted blood samples after 3 h and in serum after 2 h. At 4°C PTH was more stable in EDTA plasma (at least 72 h) than serum (at least 24 h). Central venous PTH concentrations were higher than peripheral venous concentrations. In the northern hemisphere, PTH concentrations were higher in winter than summer. PTH has a circadian rhythm characterised by a nocturnal acrophase and mid-morning nadir. Data related to frozen storage of PTH (−20°C and −80°C) were limited and contradictory. We recommend that blood samples for PTH measurement should be taken into tubes containing EDTA, ideally between 10:00 and 16:00, and plasma separated within 24 h of venepuncture. Plasma samples should be stored at 4°C and analysed within 72 h of venepuncture. Particular regard must be paid to the venepuncture site when interpreting PTH concentration. Further research is required to clarify the suitability of freezing samples prior to PTH measurement.

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Section: We Recommend Blood Samples For Pth Measurement Should Be Taksupporting

confidence: 71%

Section: Limitationsmentioning

confidence: 85%

Section: Stability In Separated Serum and Plasma At Room Temperaturementioning

confidence: 99%

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Sampling and storage conditions influencing the measurement of parathyroid hormone in blood samples: a systematic review

Hanon

Sturgeon

Lamb

2013

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…Plasma/serum was separated within 4 hours of venepuncture and stored at Ϫ80°C until assayed. Intact and biointact PTH are stable under these conditions (23,24).…”

Section: Methodsmentioning

confidence: 99%

Variability of Parathyroid Hormone and Other Markers of Bone Mineral Metabolism in Patients Receiving Hemodialysis

Gardham¹,

Stevens

Delaney

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: Clinical management of mineral bone disorder in patients with kidney failure is guided by biochemical targets, in particular parathyroid hormone (PTH) concentration. The biologic variation of PTH and other bone mineral markers was measured in hemodialysis patients to better define their role in management.Design, setting, participants, & measurements: Intact PTH, biointact (whole-molecule) PTH, calcium, albumin-adjusted calcium, phosphate, and alkaline phosphatase (ALP) were measured in nonfasting samples obtained twice a week (both short-dialysis interval) over a 6-week period in 22 stable hemodialysis patients. Concurrently, samples were obtained from 12 healthy volunteers. Intraindividual coefficients of variance (CV I ) were calculated and used to derive the reference change value (RCV) required to be 95% certain that a change has occurred.Results: CV I of all markers was significantly (P < 0.05) greater in patients than in healthy volunteers. For phosphate, ALP, and PTH this implies that an increased number of samples is required to estimate an individual's homeostatic set point. CV I of intact PTH was 25.6% in hemodialysis patients and 19.2% in healthy volunteers. A greater RCV should be used for patients (72%) compared with healthy volunteers (54%). Ideally 26 specimens should be measured to estimate a patient's intact PTH homeostatic set point (within ؎10%) with 95% probability. The CV I of biointact PTH was at least as high as that for intact PTH.Conclusions: The uncertainty of PTH estimation in an individual significantly undermines its value as a tool in the management of chronic kidney disease-mineral bone disorder using current management approaches.

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“…Many studies have found that at room temperature, PTH is more stable in plasma derived from blood samples collected into EDTA-preserved tubes than in tubes containing no preservative (48,49). PTH also seems to be more stable in EDTA-preserved whole blood than plain clotted blood samples (50).…”

Section: Sample Stabilitymentioning

confidence: 99%

PTH—A Particularly Tricky Hormone

Garrett

Sardiwal

Lamb

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryPlasma parathyroid hormone (PTH) concentrations are commonly measured in the context of CKD, as PTH concentration elevation is typical in this clinical context. Much has been inferred from this raised PTH concentration tendency, both about the state of skeletal integrity and health and also about the potential clinical outcomes for patients. However, we feel that reliance on PTH concentrations alone is a dangerous substitute for the search for, and use of, more precise and reliable biomarkers. In this article, we rehearse these arguments, bringing together patient-level and analytical considerations for the first time.

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Stability of Bio-Intact (1–84) Parathyroid Hormone ex Vivo in Serum and EDTA Plasma from Hemodialysis Patients

Cited by 14 publications

References 7 publications

Sampling and storage conditions influencing the measurement of parathyroid hormone in blood samples: a systematic review

Sampling and storage conditions influencing the measurement of parathyroid hormone in blood samples: a systematic review

Variability of Parathyroid Hormone and Other Markers of Bone Mineral Metabolism in Patients Receiving Hemodialysis

PTH—A Particularly Tricky Hormone

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